Health & insurance
The following advice is a general guide only and does not replace the advice of a doctor trained in travel medicine.
Before You Go
Make sure your travel insurance or separate private health insurance covers all possible health eventualities in Myanmar – the country's health system is far from ideal and although there are international-standard hospitals in Yangon for major incidents, an air evacuation to neighbouring countries may be required.
Consult your government's website on health and travel before departure:
New Zealand (www.safetravel.govt.nz)
Proof of yellow-fever vaccination will be required if you have visited a country in the yellow-fever zone (ie Africa or South America) within the six days prior to entering Myanmar. Otherwise, the World Health Organization (WHO) recommends the following vaccinations for travellers to Myanmar:
Adult diphtheria and tetanus Single booster recommended if none in the previous 10 years.
Hepatitis A Provides almost 100% protection for up to a year. A booster after 12 months provides at least another 20 years' protection.
Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with hepatitis A.
Measles, mumps and rubella (MMR) Two doses of MMR are required unless you have had the diseases. Many young adults require a booster.
Polio There have been no reported cases of polio in Myanmar in recent years. Adults require only one booster for lifetime protection.
Typhoid Recommended unless your trip is less than a week and only to developed cities. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available but the injection is usually recommended as it has fewer side effects.
Varicella (chickenpox) If you haven't had chickenpox, discuss this vaccination with your doctor.
Websites & Further Reading
Lonely Planet's Healthy Travel – Asia & India is packed with useful information. Other recommended references include Travellers' Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills. Online resources:
Centres for Disease Control and Prevention (CDC; www.cdc.gov)
MD Travel Health (www.mdtravelhealth.com)
World Health Organization (www.who.int/ith/)
- Pack medications in their original, clearly labelled containers.
- Carry a signed and dated letter from your physician describing your medical conditions and medications, including their generic names.
- If you have a heart condition, bring a copy of your ECG taken just prior to travelling.
- Bring a double supply of any regular medication in case of loss or theft.
- Take out travel insurance.
Availability & Cost of Healthcare
Outside of Yangon, Myanmar medical care is generally dismal, and local hospitals should be used only out of desperation. Contact your embassy for advice, as staff will usually direct you to the best options.
Be aware that getting Western-style health care may not come cheap. An initial consultation with an international doctor in Yangon will cost at least US$50.
If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention. It is always better to be assessed by a doctor than to rely on self-treatment.
Buying medication over the counter is not recommended in Myanmar, as fake medications and poorly stored or out-of-date drugs are common.
The following are the most common infectious diseases for travellers:
Dengue fever Increasingly problematic throughout Myanmar. The mosquito that carries dengue bites day and night, so use insect avoidance measures at all times. Symptoms can include high fever, severe headache, body ache, a rash and diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging.
Hepatitis A This food- and water-borne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. All travellers to Myanmar should be vaccinated against it.
Hepatitis B The only sexually transmitted infection (STI) that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact.
Hepatitis E Transmitted through contaminated food and water and has similar symptoms to hepatitis A, but is far less common. It is a severe problem in pregnant women and can result in the death of both mother and baby. There is currently no vaccine, and prevention is by following safe eating and drinking guidelines.
HIV Unprotected sex is the main method of transmission.
Influenza Can be very severe in people over the age of 65 or in those with underlying medical conditions, such as heart disease or diabetes; vaccination is recommended for these individuals. There is no specific treatment, just rest and paracetamol.
Malaria While not noted in Yangon or Mandalay, malaria (which can be fatal if untreated) is very much present throughout the rest of rural Myanmar in altitudes below 1000m. Before you travel, seek medical advice on the right medication and dosage for you; note that some areas of the country have strains of the disease resistant to Mefloquine-based drugs. Wherever you are, wear long pants and sleeves and spray insect repellent to prevent bites. Also sleep in air-conditioned or screened rooms with mosquito nets over beds.
Rabies A potential risk, and invariably fatal if untreated, rabies is spread by the bite or lick of an infected animal (most commonly a dog or monkey). Pretravel vaccination means the postbite treatment is greatly simplified. If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not prevaccinated, you will need to receive rabies immunoglobulin as soon as possible.
Typhoid This serious bacterial infection is spread via food and water. Symptoms include high and slowly progressive fever, headache, a dry cough and stomach pain. Vaccination, recommended for all travellers spending more than a week in Myanmar and other parts of Southeast Asia, is not 100% effective so you must still be careful with what you eat and drink.
Air pollution, particularly vehicle pollution, is an increasing problem, particularly in Yangon. If you have severe respiratory problems, speak with your doctor before travelling to any heavily polluted urban centres. This pollution also causes minor respiratory problems, such as sinusitis, dry throat and irritated eyes. If troubled by the pollution, leave the city for a few days and get some fresh air.
Divers and surfers should seek specialised advice before they travel to ensure their medical kit contains treatment for coral cuts and tropical ear infections, as well as the standard problems. Divers should ensure their travel insurance covers them for decompression illness. Have a dive medical examination before you leave your home country – there are certain medical conditions that are incompatible with diving, and economic considerations may override health considerations for some dive operators in Myanmar.
Rather than being overly concerned at street stalls, where food is freshly cooked to order, note that eating in restaurants is the biggest risk factor for contracting traveller's diarrhoea. Avoid shellfish, and food that has been sitting around in buffets. Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes. Eat in busy restaurants with a high turnover of customers.
Many parts of Myanmar are hot and humid throughout the year. It can take up to two weeks to adapt to the hot climate. Swelling of the feet and ankles is common, as are muscle cramps caused by excessive sweating. Prevent these by avoiding dehydration and excessive activity in the heat.
Dehydration is the main contributor to heat exhaustion. Symptoms include feeling weak; headache; irritability; nausea or vomiting; sweaty skin; a fast, weak pulse; and a normal or slightly elevated body temperature. Treat by getting out of the heat, applying cool wet cloths to the skin, lying flat with legs raised and rehydrating with water containing a quarter of a teaspoon of salt per litre.
Heatstroke is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of over 41°C, dizziness, confusion, loss of coordination, fits and eventual collapse and loss of consciousness. Seek medical help and commence cooling by getting the person out of the heat, removing their clothes, and applying cool wet cloths or ice to their body, especially to the groin and armpits.
Prickly heat – an itchy rash of tiny lumps – is caused by sweat being trapped under the skin. Treat by moving out of the heat and into an air-conditioned area for a few hours and by having cool showers. Creams and ointments clog the skin so they should be avoided.
Insect Bites & Stings
Bedbugs Don't carry disease but their bites are very itchy. They live in the cracks of furniture and walls and then migrate to the bed at night to feed on you. You can treat the itch with an antihistamine.
Bees or wasps If allergic to their stings, carry an injection of adrenaline (eg an EpiPen®) for emergency treatment.
Jellyfish In Myanmar waters, most are not dangerous. If stung, pour vinegar onto the affected area to neutralise the poison. Take painkillers and seek medical advice if your condition worsens.
Leeches Found in humid rainforest areas. Don't transmit any disease but their bites can be itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to any leech bite to help prevent infection.
Lice Most commonly inhabit your head and pubic area. Transmission is via close contact with an infected person. Treat with numerous applications of an antilice shampoo, such as Permethrin.
Ticks Contracted after walking in rural areas. If you are bitten and experience symptoms such as a rash at the site of the bite or elsewhere, fever, or muscle aches, see a doctor. Doxycycline prevents tick-borne diseases.
Fungal rashes are common in humid climates. There are two common fungal rashes that affect travellers. The first occurs in moist areas that receive less air, such as the groin, the armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream, such as Clotrimazole or Lamisil. Tinea versicolor is also common – this fungus causes small, light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.
Cuts and scratches easily become infected in humid climates. Take meticulous care of any cuts and scratches to prevent complications, such as abscesses. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection (increasing pain and redness), see a doctor. Divers and surfers should be particularly careful with coral cuts as they easily become infected.
Myanmar is home to many species of both poisonous and harmless snakes. Assume all snakes are poisonous and never try to catch one. Always wear boots and long pants if walking in an area that may have snakes. First aid in the event of a snakebite involves pressure immobilisation with an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenom is available for most species.
- Never drink tap water.
- Check bottled water seals are intact at purchase.
- Avoid ice.
- Avoid fresh juices – they may have been watered down.
- Boiling water is the most efficient method of purifying.
- Iodine, the best chemical purifier, should not be used by pregnant women or those who suffer with thyroid problems.
- Ensure your water filter has a chemical barrier, such as iodine, and a pore size of less than four microns.
By far the most common problem affecting travellers is usually caused by a bacteria. Treatment consists of staying well hydrated; use a solution such as Gastrolyte. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly.
Loperamide is just a 'stopper', but it can be helpful in certain situations, such as if you have to go on a long bus ride. Seek medical attention quickly if you do not respond to an appropriate antibiotic.
Amoebic dysentery is very rare in travellers; one sign is if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut, and then a second drug to kill the cysts.
Giardiasis is relatively common. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. The treatment of choice is Tinidazole, with Metronidazole being a second option.
Pregnant women should receive specialised advice before travelling. The ideal time to travel is between 16 and 28 weeks, when the risk of pregnancy-related problems is at its lowest and pregnant women generally feel their best. During the first trimester there is a risk of miscarriage and in the third trimester complications – such as premature labour and high blood pressure – are possible. It's wise to travel with a companion. Always carry a list of quality medical facilities available at your destination and ensure that you continue your standard antenatal care at these facilities. Avoid rural travel in areas with poor transport and medical facilities. Most of all, ensure that your travel insurance covers all pregnancy-related possibilities, including premature labour.
Malaria is a high-risk disease in pregnancy. WHO recommends that pregnant women do not travel to areas with Chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy.
Traveller's diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many of the drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.
Birth-control options may be limited, so bring adequate supplies of your own form of contraception. Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as Clotrimazole. A practical alternative is a single tablet of Fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.
Throughout Myanmar traditional medical systems are widely practised. Folk remedies should be avoided, as they often involve rather dubious procedures with potential complications. In comparison, traditional healing systems such as Chinese medicine are well respected, and aspects of them are being increasingly used by Western medical practitioners.
All traditional Asian medical systems identify a vital life force, and see blockage or imbalance as causing disease. Techniques such as herbal medicines, massage and acupuncture are used to bring this vital force back into balance or to maintain balance. These therapies are best used for treating chronic fatigue, arthritis, irritable bowel syndrome, skin conditions and other chronic ailments. Don't use traditional medicines to treat serious acute infections, such as malaria.
Be aware that 'natural' doesn't always mean 'safe', and there can be drug interactions between herbal medicines and Western medicines. If you are using both systems, ensure that you inform both practitioners what the other has prescribed.